An intelligent unsupervised technique for fraud detection in health care systems

Abstract

Healthcare is an essential part of people’s lives, particularly for the elderly population, and also should be economical. Medicare is one particular healthcare plan. Claims fraud is a significant contributor to increased healthcare expenses, though the effect of it could be lessened by fraud detection. In this paper, an analysis of various machine learning techniques was done to identify Medicare fraud. The isolated forest an unsupervised machine learning algorithm which improves overall performance while detecting fraud based upon outliers. The goal of this specific paper is generally to show probable dishonest providers on the ground of their allegations. Obtained results were found more promising compared to existing techniques. Around 98.76% accuracy is obtained using an isolated forest algorithm.